Pneumonia and HCM

[Laoshur]

A few days ago Art Geddes wrote that one reason that he was having a myectomy now as opposed to years ago was that he had new and increasing symptoms. Among those, he included pneumonia and chronic bronchitis. I am curious. Is there a connection between HCM and pneumonia? Certainly my own experience indicates that there is a connection between CHF and pneumonia, but I am not sure of cause and effect. Does the chf cause the pneumonia or the pneumonia cause the chf or do both stem from a third cause? Any ideas? After at least 4 cases of very hard to treat pneumonia in 2 1/2 years, in spite of having a pneumonia shot, I am eager to find out. Even more specifically I would like to know if there is any connection with gradient.

In addition, and perhaps even more basically, I am curious about the causes of right sided heart failure in people with HCM. If the pacing had coordinated my beats so that the heart is beating nearly normally, as the last echo I had indicated, why am I still struggling with CHF? I gained 6 pounds in the last two days and had both leg and ankle swelling and lung congestion, so this is a relevant question. Somehow the objective data of weight gain and loss does not seem to fit the objective data from the echo. Any ideas anyone?

Rhoda

[Lisa Salberg]

There is no direct connetion between HCM and pneumonia. However those with chonic illness have a greater chance of getting pneumonia. I too have had pneumonia so I completely understand why you would think a specific connection. I am not aware that there is any connection between obstruction and pnuemonia - I will ask around and get back to you on this.
Here is a fact sheet from the American Lung Association

Pneumonia Fact Sheet

October 2003

"Pneumonia" encompasses many different diseases that involve infection or inflammation of the lungs. Pneumonia is caused by a variety of agents such as bacteria, viruses, and mycoplasmas, among others. Pneumonia remains an important cause of morbidity and mortality in the United States; in 1996 there were an estimated 4.8 million cases of pneumonia.


In 1996 (latest data available), there were an estimated 4.8 million cases of pneumonia resulting in 54.6 million restricted-activity days and 31.5 million bed days.

In 2000, there were approximately 1.3 million hospitalizations, 1.3 million emergency room visits, and 63,548 deaths recorded in the United States.

Pneumonia affects the lungs in two ways. Lobar pneumonia affects a lobe of the lungs, and bronchial pneumonia can affect patches throughout both lungs.

The major types of pneumonia are bacterial pneumonia, viral pneumonia, and mycoplasma pneumonia. Others include pneumocystis carinii pneumonia (PCP), which is caused by a fungus, primarily in AIDS patients. Pneumonia also may be caused by the inhalation of food, liquid, gases or dust, and by fungi. Certain diseases, such as tuberculosis, can cause pneumonia.

People considered at high risk for pneumonia include the elderly, the very young, and those with underlying health problems, such as chronic obstructive pulmonary disease (COPD), diabetes mellitus, congestive heart failure and sickle cell anemia. Patients with diseases that impair the immune system, such as AIDS, or patients with other chronic illnesses, such as asthma, or those undergoing cancer therapy or organ transplantation, are particularly vulnerable.

Approximately 50 percent of pneumonia cases are believed to be caused by viruses and tend to result in less severe illness than bacterial-caused pneumonia. The symptoms of viral pneumonia are similar to influenza symptoms, including fever, dry cough, headache, muscle pain, weakness, high fever, and increasing breathlessness.

Viral pneumonia is less common in normal adults with a fully functioning immune system; however, most pneumonia in the very young is caused by viral infection, including respiratory syncytial virus (RSV).

Streptococcus pneumoniae is the most common cause of bacterial pneumonia. The bacteria can multiply and cause serious damage in healthy individuals, especially when the body's defenses are weakened. Pneumococcus can cause serious infections of the lungs (pneumonia), the bloodstream (bacteremia), the covering of the brain (meningitis), and other parts of the body. Pneumococcal pneumonia accounts for 25 to 35 percent of all community-acquired pneumonia and an estimated 40,000 deaths yearly.

The onset of bacterial pneumonia can vary from gradual to sudden. In most severe cases, the patient may experience shaking/chills, chattering teeth, severe chest pains, sweats, cough that produces rust colored or greenish mucus, increased breathing and pulse rate, and bluish colored lips or nails due to lack of oxygen.

Mycoplasmas are the smallest free-living agents of disease in man, with characteristics of both bacteria and viruses. The agents generally cause a mild and widespread pneumonia. The most prominent symptom of mycoplasma pneumonia is a cough that tends to come in violent attacks, but produces only sparse whitish mucus. Mycoplasma are responsible for approximately 20 percent of all cases of pneumonia.

Early treatment with antibiotics can cure bacterial pneumonia and speed recovery from mycoplasma pneumonia. There are generally no effective treatments for most types of viral pneumonia, which usually heal on their own.

Pneumococcal vaccination is effective in preventing invasion of pneumococcal infections. People over age 65 and those in high-risk groups are advised to receive the pneumonia vaccine. The vaccine is effective in approximately 80 percent of healthy young adults; however, it may be less effective in people in high risk groups.

In addition, influenza vaccination is recommended since pneumonia often occurs as a complication of the flu.

Pneumonia and influenza vaccines are covered by Medicare, as well as some state and private health insurance.


The pneumonia vaccine is generally given once, although revaccination after 3-5 years should be considered for children with nephrotic syndrome, asplenia, or sickle cell anemia who would be less than 11 years old at revaccination. Revaccination should also be considered for high-risk adults who received their first shot six years ago or more, and for those who are shown to have rapid decline in pneumococcal antibody levels.

[Pam Alexson]

I think the bold face segment of the fact sheet says a lot.

A person with fluctuating inflamation and fluid in the lungs as a result of an already compromised health issue is certainly more likely to present with pneumonia. The area of insult becomes engorged with fluid and toxins that become difficult to remove due to the extra burden. The individual becomes ripe for an onslaught of any number of complications, one of which is any form of the pneumonias. A consequence of a chonic illness is the bodies poor hygienic ability of many areas . Our bodies can not heal well or effectively or on a normal schedule if we are not generally normal or healthy due to compromising health issues.

As an aside , I was diagnosed as having pneumonia many times via a chest x-ray and audible lung sounds and elevated lab values( all prior to my HCM diagnosis. Interesting to note, my pulmonologist has seen those x-rays. He said , " you did not have pneumonia, they were episodes of typical CHF exacerbated by your heart condition."

Through my experience , I will say when I did not slow down and pushed myself too far, I disregarded some of the signs I was getting that ultimately was telling me my heart was not able to keep up and I got sick a lot. I think with HCM I had to change the way I thought about how I could live and I had to adhere to my bodies guidelines stringently.

I do believe that there are many side effects to an HCM heart and systems are compromised as a result.

Another thing this makes me think of is wouldn't it be helpfull if we were able to fit on a graph to track how our HCM may correlate with anothers. We might have a better feel for where we stand individually. Then in tern wouldn't it then be nice to have a set of defined parameters or suggested guidelines as to what levels of activities each individual could safely aim for.

I believe this is very hard to define our individual HCM , symptoms, limitations and to know if we should back off or if we could step it up a bit. I do not believe there have been studies conducted but an area of investigation I would find helpfull is to know if there are things that could definitely or probably effect an outcome positively or negatively. Sort of like when someone has diabetis they have a diet and plan . I guess that may all be in the future. ( I like graphs)

Pam